Jolley Suzanne, Onwumere Juliana, Bissoli Sarah, Bhayani Pooja, Singh Gurpreet, Kuipers Elizabeth, Craig Tom, Garety Philippa
Institute of Psychiatry,King's College London,UK.
Behav Cogn Psychother. 2015 Jul;43(4):478-89. doi: 10.1017/S1352465813001100. Epub 2013 Dec 23.
Historically, it has been difficult to demonstrate an impact of training in psychological interventions for people with psychosis on routine practice and on patient outcomes. A recent pilot evaluation suggested that postgraduate training in Cognitive Behavioural Therapy for Psychosis (CBTp) increased the delivery of competent therapy in routine services. In this study, we evaluated clinical outcomes for patients receiving therapy from therapists who successfully completed training, and their association with ratings of therapist competence and therapy content.
To characterize the therapy delivered during training and to inform both a calculation of effect size for its clinical impact, and the development of competence benchmarks to ensure that training standards are sufficient to deliver clinical improvement.
Paired patient-reported outcome measures (PROMS) were extracted from anonymized therapy case reports, and were matched with therapy ratings for each therapist.
Twenty clients received a course of competent therapy, including a high frequency of active therapy techniques, from nine therapists. Pre-post effect size for change in psychotic symptoms was large (d = 1.0) and for affect, medium (d = 0.6), but improved outcomes were not associated with therapist competence or therapy content.
Therapists trained to research trial standards of competence achieved excellent clinical outcomes. Therapy effect sizes suggest that training costs may be offset by clinical benefit. Larger, methodologically stringent evaluations of training are now required. Future research should assess the necessary and sufficient training required to achieve real-world clinical effectiveness, and the cost-effectiveness of training.
从历史上看，很难证明针对精神病患者的心理干预培训对常规临床实践和患者预后产生影响。最近的一项初步评估表明，精神病认知行为疗法（CBTp）的研究生培训增加了常规服务中合格治疗的提供。在本研究中，我们评估了接受成功完成培训的治疗师治疗的患者的临床结局，以及这些结局与治疗师能力评级和治疗内容的关联。
描述培训期间提供的治疗，为计算其临床影响的效应量以及制定能力基准提供依据，以确保培训标准足以带来临床改善。
从匿名的治疗病例报告中提取配对的患者报告结局测量指标（PROMS），并将其与每位治疗师的治疗评级相匹配。
20名患者接受了9名治疗师提供的一个疗程的合格治疗，其中包括高频率的积极治疗技术。精神病症状变化的前后效应量较大（d = 1.0），情感方面的效应量中等（d = 0.6），但结局改善与治疗师能力或治疗内容无关。
接受研究试验能力标准培训的治疗师取得了出色的临床结局。治疗效应量表明培训成本可能会被临床益处所抵消。现在需要对培训进行更大规模且方法严格的评估。未来的研究应评估实现现实世界临床有效性所需的必要和充分培训，以及培训的成本效益。
